| NPI | 1104158773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS55766) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI02913300) |
| 183500000X Pharmacist (Licence: PA RP450457) | |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2021-01-12 |